Ocular syphilis:a case series of four patients and a review of the literature

Background:The incidence of syphilis has been increasing in the United States over the last two decades,with a more recent increase among women.Ocular syphilis is an uncommon but important complication of syphilis,most often presenting as posterior or panuveitis in late or latent syphilis of unknown duration.Untreated ocular syphilis may lead to permanent vision loss,underscoring the importance of appropriate evaluation and treatment of ocular syphilis.Case Description:In a retrospective,non-contiguous case series,we highlight four patients diagnosed and treated with ocular syphilis at a single institution.Four presentations of ocular syphilis are illustrated:anterior and intermediate uveitis,optic neuritis,posterior uveitis,and panuveitis.All patients initially presented with a decreased visual acuity(VA).One patient had a previous diagnosis of human immunodeficiency virus(HIV).Three patients were treated with intravenous(IV)penicillin and one patient with IV ceftriaxone.All had a return to their baseline VA after their course of treatment.Conclusions:Syphilis may go undetected without a high index of clinical suspicion due to its nonspecific presentations.All patients with ocular inflammation should have syphilis testing as a part of their infectious workup with both treponemal and non-treponemal testing.Patients diagnosed with syphilis and are not known to be HIV-negative should undergo testing for HIV due to the high rate of co-infection.Early diagnosis and prompt treatment after onset of symptoms may contribute to a more favorable prognosis for ocular syphilis.

Ocular syphilis: resurgence of an old disease in modern Malaysian society

Dear Editor,Syphilis is a spirochaetal bacterial sexually transmitted disease（STD） caused by Treponema pallidum. Outbreaks of syphilis have been described in Western communities, especially in men who have sex with men（MSM） and people infected with human immunodeficiency virus（HIV）^（[1]）. Reports of the condition from Asian countries remains limited.

Ocular syphilis resurgence in an urban underserved community in the United States

AIM:To evaluate the clinical characteristics,demographics,and visual outcomes of patients with ocular syphilis at an urban hospital to increase awareness and assist in earlier diagnosis and treatment of the resurgent disease.METHODS:A retrospective chart review was performed on patients with ICD-9 and ICD-10 diagnosis codes correlating with syphilis or syphilis-related ocular diseases between 2010 and 2019.Variables evaluated included age,gender,race,vision,ocular findings,human immunodeficiency virus(HIV)status and men who have sex with men status,recreational drug and alcohol use.RESULTS:Ocular syphilis was diagnosed in 40 patients(53 eyes)of a total of 229 patients who tested positive for syphilis via serum and/or cerebrospinal fluid treponemal testing from 2010-2019.Among patients with ocular syphilis,most patients were males,aged 45 or above and Black,and had no diagnosed HIV infection.Approximately 50%patients had 20/40 vision or better.Nearly 50%had nongranulomatous anterior uveitis as their initial presentation,and 49%of patients had involvement of the posterior segment.Neovascular glaucoma(5.7%),papillitis(7.5%),vasculitis(5.7%),and retinal detachment(5.7%)were rarer presentations of the disease and were associated with a poorer visual prognosis.CONCLUSION:Given the increased prevalence and protean manifestations of syphilis,early diagnosis and treatment are paramount.More studies on ocular syphilis are warranted to understand this resurging disease.